What are Grand Rounds?
In the late 19th century, Sir William Osler, the father of modern medicine, one of the founders of Johns Hopkins Medical School, and John Hopkins’ first professor of medicine, introduced an innovative physician-to-physician teaching forum to disseminate cutting-edge medical knowledge at the bedside. This became known as grand rounds.
During grand rounds a patient’s problem is presented to medical students, residents, interns, attending physician and other staff. The goal is to teach by using the patient’s presenting problem as a vehicle to learn patient management at the bedside.
Lethargic and Responding to Painful Stimuli Only
A 2-year-old female is brought to the Emergency Department at Royal Children’s Hospital in Melbourne, Australia, by her parents.
The parents state that the child was seen in the general outpatient department two days ago and was diagnosed with otitis media and treated with oral amoxicillin antibiotics. The child seemed to be improving until earlier in the day when she became irritable and less active than usual.
The child is lethargic and can only be aroused to painful stimuli. Physical examination reveals that the child’s fontanel is bulging, and there is significant neck rigidity (stiffness).
The paediatrics registrar on call performs a lumbar puncture (spinal tap), with the CSF being visibly hazy. Gram stain of the CSF shows white blood cells and a few gram-positive cocci (bacteria).
What’s the Diagnosis?
What is the most likely diagnosis, how would you treat it, and should the patient be excluded from school?
UHSA students, if you know the answer, please contact Dr Mangum via email for extra-credit on an upcoming quiz or examination.
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